Patricia Poitevien's blog

Feb 05 18:45

Extremes

 

1/23/10 – 9pm

The word to describe today is extremes. Extremes of life and death, of selflessness and ego-mania, of calm and chaos, of hope and despair. How individuals survive life's relentless pendulum is a mystery to me - I barely survived one day.

What people don't say when they are reporting on Haiti is that Haitians are still living. There is so much focus on death and desperation (people who still have homes and intact families and food and health can afford to dwell on death and glamourize desperation) that we all forget for millions of Haitians, on the morning of January 13th they had no choice but to wake up and continue living.

On our way to L’Hopitale Generale (HUEH) this morning I am struck by the liveliness – the cafes serving food, the marchandes arranging their wares in the marketplace, baskets balanced perfectly on their heads, the camionettes, brightly painted, horns blaring, whizzing by on the roads packed with passengers all on their way to the rest of their lives. All this set against a backdrop of rubbles, stone tombs that now house the remains of loved ones. I am so proud to be Haitian in this moment – to bear witness to their strength and resilience is life-altering.

We arrive at HUEH and I am stunned. Tents occupy all areas of outdoor space, and under the tents patients. Mattresses on the floor, broken stretchers, old cots all packed together tightly to make space for people – but this is not what surprises me. It is something about the appearance of the tents themselves that is shocking. Each tent is adorned with someone’s flag, symbol, color, alphabet soup, tribal tattoo – anything to distinguish one organization’s colony from another. Anything to symbolize that despite the fact that they are on Haitian soil, in a Haitian Hospital Haitian rules don’t apply in this tent. This tent is an extension of our country, our culture, our norms, so please present your passport prior to entry. Yet at the same time, I am also overwhelmed by the international representation; taken aback by the notion that the Norwegian Red Cross cares enough about this western third of a tiny island in the Caribbean that they would travel across of the globe to come care for our wounded. I am angry and impressed, resentful and grateful. I am conflicted.

I find my way to the pediatric unit and walk around. 5 large tents, 2 small. The large tents are divided into 1 pre-surgical, 2 operating rooms, 1 post-surgical, 1 medical. The small tents are used for medical triage. Interspersed there are additional large tents where I hear women wailing – Maternity. The children lie on mattresses and mats strewn on the ground. Space is tight and it is difficult to tell which parents belong to which children, as the adults are forced sit, squat, and lie in the 2 inch space that may or may not separate the beds. I am in the post-op tent and most of the children wear browning casts and bandages. I find a child in the corner lying on his mattress, a piece of cardboard wrapped around his calf with a bandage, his leg leaning up against a chair, the end of the bandage tied to a water bottle slung over the back of the chair. I ask the Mother what his diagnosis is and she tells me he has a fracture. Traction. There are no sheets, and no hospital gowns. Patients wear the clothing they have, often tattered and bloody. The heat has begun to rise (the tent’s construction allows for no ventilation) and flies are everywhere. I hear a girl whimper “mouches” as she swats flies away through tears. There are no functioning bathrooms so children, even potty-trained ones are forced to use diapers. Unfortunately there are not enough diapers to go around, and the older children don’t have diapers that fit. I later find out that the Hospital can only afford to provide one meal a day to these children, and that parents who may have otherwise had means to buy some food outside the hospital for their children do not dare leave as they risk not being allowed back onto hospital grounds.

I inquire as to who is in charge, and get three answers. I choose to search out the one Haitian name in the group. I fall, instead, upon an American - a pediatrician in training, cutting her teeth on disaster relief. I introduce myself (first names only here) and offer assistance. She quickly tells me the tents are run by the Swiss, and that this is the Swiss Hospital. “Really?” I think, “I thought it was HUEH.” (inside voice). She then proclaims her love for me since I speak the language of the country she is currently in (not Switzerland – Haiti) and begins to turn away. I hear a child moaning and turn to the direction of the sound, “What’s wrong” I ask the Mother. She shrugs and points to his left arm and leg. “I think they are broken – they hurt him so much.” The child has what appears to be a fracture of the left humerus and a compartment syndrome, old now, of his L femur. I turn to my colleague and ask her if the child has been seen by a surgeon. She replies, “the Swiss will get to him.” I am confused. “We have a pediatric orthopedic surgeon from NYU who has arrived with me today and is anxious to see patients. I can have him come down and see this child now.” I tell her. “Well, we shouldn’t steal the Swiss patients.” She responds. Swiss patients? These are all Haitian patients! Stealing patients? The number of dead and injured is said to be somewhere around 500,000 – I didn’t think stealing patients would be an issue. I am annoyed. I need to find the Swiss.

I go to the pre-op tent and I introduce myself to two elderly, perspiring, white gentlemen and am told one is in charge of the surgical patients, and the other is in charge of the entire “Swiss Pediatric Hospital”. The tent is full of patients waiting to be seen. I give them my credentials, explain to them that most of the work I do is peri-operative care and offer any help they might need. The physician in charge of the entire peds unit begins to pull me aside. At first I assume I am in the way of a patient transport, but I realize he is leading me outside the tent. I am confused. He continues to pull me gently by the arm until we are beneath the shade of a pye zanman. He proclaims in French, “Oh yes, much better…now I can talk. It is absolutely stifling in those tents…”

I think I am in an alternate universe. I decide to just start with the basics: see patients. I speak with the nurses and there is a new admission: a one month old with vomiting and mild dehydration. I speak with Mom and she tells me that the infant takes breast milk without difficulty but when she gives him Gerber he vomits. I explain to her that he is too young for baby food, and that she should stick with her breast milk. She confides in me that she has not been eating well, and knows her supply is dwindling. She fights back tears. I excuse myself, as I fight back my own. The pain of being unable to provide for your child is difficult to describe. Words like “searing” and “suffocating” come to mind. I think about my second son, a beautiful chubby 5 month old that knows nothing but breast milk. I reflect on the interruption of his nursing routine caused by this trip, my anxiety about how much milk I left stored for him, whether he would run out and have to be given formula, whether he would take the formula, whether I could keep my milk supply up while in Haiti. I compare my anxiety to her fear, my circumstances to her fate, my choice to be here to her doom. I try to rationalize the disparity between my son’s life and hers. My mind is racing; emotions and professional judgment, duking it out, and I need to go back to the bedside. I ask her to demonstrate her feeding technique. He latches on well, and she is producing some milk. We have no formula to give out to parents. I tell her if she can afford to by Gerber, she should save that money to buy food for herself and nurse him vigorously. She looks hopeless. I tell her I am nursing, and can give her my breastmilk if she wants. She shakes her head. I apologize for having nothing else to offer her. Her son voids. I tell her we will keep him for some hours of observation, but that I don’t think he will stay the night. She smiles, weakly…obviously disappointed…

…A tall well-dressed man approaches me and says excitedly in French, “Are you aware that the First Lady is here to visit the ward?” I shake my head, disinterested. In what seems like mere seconds the tent is descended upon by cameras, and microphones. A petite silver-haired woman in a neat business suit adorned with a scarf, her haired pulled neatly in a chignon, walks in to the ward and shakes my hand as she feigns interest in the patient beside me. She poses for several photographs. The Mothers in the room stare silently. She touches a child’s hand snap, flash, puts her arm around a mother snap, flash. My American colleague arrives and shakes the First Lady’s hand, obviously excited snap, flash. I leave the tent, annoyed…

…As I walk away, I pass another group of cameras orbiting around the universe of Sanjay Gupta, MD…more annoyed…

I see a small group of people running towards me. One of them is carrying a baby, he shouts,” Where is Peds?” I run up to them and realize one is holding a newborn, one man is giving chest compressions and one is bagging. I ask them to follow me and begin running back to the tent. “What’s the story?” I ask. “We have no idea. Someone just handed us this baby.” We run pass Sanjay, and back to the tent. We lay her down. She has no pulse. “Does anyone have a story?!” I shout. “She’s an ex-32 wker. 2 days old. She’s been seizing 20 minutes or more.” “Can I have Ativan?”  I scream to no one in particular. I ask them to stop bagging – no spontaneous respirations. “Can I have 3.0 ET tube?” again to no one. I hear back, “We don’t have any of that doc!” I look around as the EMT continues to bag her with a mask that is entirely too big for her face. No chest rise. My colleague is back. “What’s going on?!” she yells. Someone gives her the story. She feels for pulses. “Guys, we can’t do anything with this kid.” she shrugs. The EMT is relentless and continues with chest compressions. I feel for a pulse again. “She has a pulse!” I scream, but realize I have nothing with which to intubate her. There is no pediatric crash cart in the peds tent, and the EMT’s only have adult resuscitation equipment. EMT one is bagging, EMT two is giving chest compressions. I run out of the tent and to the OR….

Daiana is at the head of a table with David and Ken hovering over a patient. They are operating, she is monitoring. The OR is cool and calm (speaking comparatively, of course). “Daiana! I need a 3.0, a blade, Ativan, epi and atropine!” I can barely speak. She runs over to me and starts rummaging through boxes. She hands me the tube and the blade and a vial of valium after what feels to be an eternity. I run out, followed (unbeknownst to me) by two nurses…

We run past Sanjay again, and push one of his entourage out of the way. We arrive at the tent. As I approach the bed, one of the nurses announces, “ I am a pediatric nurse anesthetist. I can get that airway.” I quickly hand over the tube and blade to him. He secures the airway. I administer the valium. “She needs to go to the Comfort.” someone shouts. We lift her and bring her to an army truck that will take her. The nurses accompany her to the ship…the back of the army I sigh, exhausted and sweating…it’s only 2:30 I feel like I have been here forever…

Feb 01 22:13

Looking back...

We are back. Ten days ago we all embarked on an incredible journey to do some incredible things. Although we succeeded in many ways, this is no time for pats on the back or congratulatory high-fives. We all return home with a terrible nagging sense that there is so much more to do.  Ken began designing proposals for future efforts and sending emails out as early as Saturday morning, while I received a panicked voicemail from Daiana Saturday night, "Did we leave too soon?". David and I spent time between his cases today discussing what our next steps in Haiti should look like.

It is now our responsibility to take the observations made during those eight days and distill them into a plan for the future. What role do we want to play during this tragically historic moment in Haitian history? What will our relationship with Haiti look like next week? a month from today?  a year from today?

Unlike our fearless leader, Fritz, I did not have access to email or the internet while in Haiti. As a result all my thoughts and observations on the trip were recorded the good old-fashioned way: in a journal. Now that we must look back, I find myself leafing through that journal, compelled to share some of my experiences, as a woman, as a Haitian-American and as a physician.

1/22/10

We are here. Its been 11 years since I was last in Haiti. I traveled in 1999 for Carnavale - I have such vivid memories of carefree celebration - so different from now. Prior to 2000 my travel to Haiti was fairly regular - at least once yearly - occasionally for volunteer work in Hospitals and clinics, mostly for fun. I was born in the US to fanatical parents that felt it their duty to instill in their children "Haitian Pride". I have always had family and friends to visit which served as a great excuse to take the 4 hour plane ride out of JFK, but frankly my trips to Haiti were much more than just social jaunts. I felt overwhelmingly grounded when I was in Haiti - plugged into my family and history in a way I never could be in the States. There is something about being surrounded by your parents' spoken language that is transformative. I loved going to Haiti...

On 1/12/10 I was on my way out of the hospital when my husband told me about the earthquake. He had not heard yet from my parents or his Father. We didn't understand the gravity of what had occurred until hours later. We spent the next several days trying to contact family, hearing news of those who were fortunate and those who were not, watching gruesome footage still in disbelief. My parents were Ok, and so were my uncles...eventually we received word from my Father-in-Law...then we began planning the trip....

So now we are here. Its dark out, and I haven't seen the city - all the better, I think. My colleagues comment about the smells, but all I smell is Port-au-Prince. "When the level of destruction hits me," I think to myself," I'm going to lose it...but not now. Now I'm OK." I speak to our driver and ask questions about the general state of things. "We've been sent back to zero and have to start once again from there," he says in Kreyol. "I estimate that after all of the injuries and the amputations 40% of Haitians will be disabled. What in the world are they going to do now? Haiti is no place for someone disabled." I nod in agreement and sit back. After 206 years of independence "zero" is a terrible place to start... 

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